Healthcare Provider Details

I. General information

NPI: 1699367375
Provider Name (Legal Business Name): MATTHEWS-VU MEDICAL GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 02/12/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 N WEBER ST STE 130
COLORADO SPRINGS CO
80907-7524
US

IV. Provider business mailing address

4190 E WOODMEN RD STE 100
COLORADO SPRINGS CO
80920-8075
US

V. Phone/Fax

Practice location:
  • Phone: 719-633-5660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATE BOGUE
Title or Position: CREDENTIALING
Credential:
Phone: 719-632-4455